International Affiliate Membership Application

Mailing Address (if different)

Street Address (line 1)

Street Address (line 2)

Street Address (line 3)

City

Postal Code

Province

Country

What is your type of organization?

Broker Agency Wealth Management/Investment Firm Bank Other (Please specify below)

Other

Is your company a multi-national company?

Yes No

If your company is multi-national, what is the name of your parent company?

Who in your company will be our primary contact?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

Who in your company should receive the membership invoice?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

Your membership entitles your company to receive many valuable benefits, please let us know who the Senior Executives responsible for the following areas are in your company.

What is the name and contact information for your chief executive officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

What is the name and contact information for your chief marketing officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

What is the name and contact information for your chief research officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

What is the name and contact information for your chief selection/recruitment officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

What is the name and contact information for your chief distribution officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

What is the name and contact information for your chief human resources officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

What is the name and contact information for your chief agent and field management development officer?

First/Given Name

Last/Family Name

Title

Email Address

Phone Number

Once your membership is fully processed (membership dues have been paid), can we announce your membership on social media (LinkedIn, Facebook, Twitter)? Yes No

If you have any questions, please contact global@limraloma.com.

Company Information

Mailing Address (if different)

What is your type of organization?

Is your company a multi-national company?

Who in your company will be our primary contact?

Who in your company should receive the membership invoice?

Your membership entitles your company to receive many valuable benefits, please let us know who the Senior Executives responsible for the following areas are in your company.

What is the name and contact information for your chief executive officer?

What is the name and contact information for your chief marketing officer?

What is the name and contact information for your chief research officer?

What is the name and contact information for your chief selection/recruitment officer?

What is the name and contact information for your chief distribution officer?

What is the name and contact information for your chief human resources officer?

What is the name and contact information for your chief agent and field management development officer?